Obstetric Emergencies

Question 1

What happens in APH?

Answer 1

Bleeding from anywhere in genital tract after 24th week
Causes: Low lying placenta, Vasa praevia, Minor/major abruption and infection

Question 2

What happens in Low Lying placenta?

Answer 2

Placenta that implanted into lower segment, may cover full or part of praevia
- Diagnosed at 20W USS, rpt 32W USS to confirm if low lying

Question 3

How is LLP managed?

Answer 3

Avoid intercourse, present if bleeding/pain
- Admission if recurring bleeds
- Elective LSCS at 37/40

Question 4

What happens in Bleeding placenta praevia?

Answer 4

A-E, Examination, Foetal Monitoring + Delivery, Steroids if <34 weeks
Major Bleed: 2x 14/16 G cannulas, IV fluids, X match 6 units and inform senior team

Question 5

Describe Vasa Praevia

Answer 5

Foetal Vessels throughout membrane coursing over internal cervical OS and below foetal presenting part, Major foetal risk with Haemorrhage, CTG abnormalities

Question 6

How do you manage AIP?

Answer 6

Look at 20W scan for anterior LLP if previous CS
- Loss of definition between wall of uterus and abnormal vasculature
- Possible interventions: Hysterectomy, leave placenta in place, cell salvage, IR
- Elective CS at 36-37W
MDT approach

Question 7

Describe Placenta Abruption?

Answer 7

Premature separation of placenta from uterine wall from baby
- Foetal distress and maternal shock potentially
Tense woody, hard uterus and emergency

Question 8

What complications can occur following APH?

Answer 8

Premature labour/delivery, Blood transfusion, Acute tubular necrosis, DIC, PPH, ITU or ARDS

Question 9

Describe parts of Severe Pre-Eclampsia

Answer 9

• Hypertension and Proteinuira +/-
• Severeheadache, Papilloedema, Clonus, Liver Tenderness, Visual Disturbances, Abnormal Liver enzymes and Platelet count declines

Question 10

How is Pre-Eclampsia managed?

Answer 10

1) Stabilise BP e.g. Nifedipine, Labetalol
2) Check Blood inc FBC, platelets, Renal and Liv function
3) MgSO4
4) Monitor urine output e.g. Fluid restrict to 80 mls/hour
5) Treat coagulation defects
6) Foetal Wellbeing (CTG, USS for growth)
7) Delivery!

Question 11

Describe Eclampsia

Answer 11

Onset of seizures in Woman with Pre-Ec (Always until proven otherwise!)

Question 12

How is Eclampsia managed?

Answer 12

IV MgSo4 over 5 mins, followed by 1g/hour maintained for 24h
Recurrent seizures need further doses
- Treat Hypertension (Labetalol)
(STABILISE Mum first then DELIVERY baby!)

Question 13

How should Sepsis be managed?

Answer 13

Advise pregnant women to be immunised for flu and covid
- SEPSIS 6 O2, Bloods, IV Abx, IV Fluid, HB and lactate, Measure hourly urine output

Question 14

What are the maternal RF for Sepsis?

Answer 14

Obesity, Diabetes, Impaired immunity, Anaemia, Vag discharge, Pelvic or Strep B infection Hx, Amniocentesis

Question 15

What happens in Cord Prolapse?

Answer 15

Cord presents first, after rupturing membrane and exposure of cord –> Vasospasm with high chance of fetal morbidity and mortality

Question 16

What are RF of cord prolapse?

Answer 16

Premature membrane ruptures, Polyhydramnios, Long UC, Foetal malpresentation, Multiparity

Question 17

How is Cord Prolapse managed?

Answer 17

Infuse fluid into blader via catheter
Trendelenburg position
Constant foetal monitoring
Alleviate cord pressure
Transfer to theatre and be ready for delivery

Question 18

What is Shoulder Dystocia?

Answer 18

Failure for anterior shoulder to pass under symphysis pubis after foetal head delivery
(Intrapartum Emergency)

Question 19

What are the RF for SD?

Answer 19

Macrosomia, Maternal Diabetes, Previous SD, Mat and Foetal disproportion, Postmaturity, Prolonged 1st/2nd stage of Labour

Question 20

How is SD managed?

Answer 20

HELPER
H: Call for help
E: Evaluate for episiotomy
L: Legs in mcroberts
P: Suprapubic Pressure
E: Enter pelvis
R: Rotational manoeveure
R: Remove post arm
(Replace head and deliver by LSCS)

Question 21

What are the SD complications?

Answer 21

Foetal: Hypoxia, Fits, Cerebral palsy/injury to BP
Maternal: PPH, Extensive Vaginal tear and psychological

Question 22

What is PPH?

Answer 22

1O: Blood loss >500mls within 24hrs
2O: After 24hrs up to 12 weeks, Minor 500-1000mls, Major >1000mls

Question 23

What are causes of PPH?

Answer 23

4Ts
Tissue (Ensure placenta complete)
Tone Ensure utuerus contracted
Trauma: Look for tears
Thrombin: Check for clotting (RPC transfusion)

Question 24

What are RF of PPH?

Answer 24

Big baby, Nulliparity, Multiple Pregnancy, Precipitate/prolonged labour, Maternal pyrexia, Operative delivery or shoulder dystocia, PPH hx

Question 25

What are the managements of PPH?

Answer 25

Treat cause, surgery and Meds: Sytocinon, Ergometrine,, Haemobate, TXA